Difference between revisions of "20,000 nerve endings"

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{{Citation
 
{{Citation
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| Text=… neither of these [figures >10,000 and >20,000] is anywhere near the truth, because they are an order of magnitude too high.
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|Text=… neither of these [figures >10,000 and >20,000] is anywhere near the truth, because they are an order of magnitude too high.
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| Author=[[Ken McGrath]]
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|Author=[[Ken McGrath]]
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| ref=<ref name="footnote2">see footnotes 27 and 31</ref>
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|ref=<ref name="footnote2">see footnotes 27 and 31</ref>
 
}}
 
}}
 
{{Citation
 
{{Citation
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| Text=In orders of magnitude, the number has to be >1,000 and <10,000.
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|Text=In orders of magnitude, the number has to be >1,000 and <10,000.
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| Author=[[Ken McGrath]]
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|Author=[[Ken McGrath]]
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| ref=<ref name="footnote2" />
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|ref=<ref name="footnote2" />
 
}}
 
}}
 
I wish to thank [[Ulf Dunkel]] and [[Lindsay R. Watson]] for support and advice in the preparation of this article and [[Ken McGrath]] for giving his consent and information about anatomy and innervation of the [[foreskin]].<ref name="Approvals">Approvals to the first publication by e-mail to the author: see below</ref>
 
I wish to thank [[Ulf Dunkel]] and [[Lindsay R. Watson]] for support and advice in the preparation of this article and [[Ken McGrath]] for giving his consent and information about anatomy and innervation of the [[foreskin]].<ref name="Approvals">Approvals to the first publication by e-mail to the author: see below</ref>
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=== The myth ===
 
=== The myth ===
  
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A frequent argument against the non-therapeutic [[foreskin]] amputation is the concept that the [[foreskin]] not only contains numerous nerve endings and is more sensitive for touch than the [[Glans penis|glans]], but also that the number of nerve endings is “more than 10,000”, "(more than) 20,000" or even "up to 70,000" or “100,000”. There appears to be no reliable evidence for these figures.<ref name="Appendix">see Appendix: Documentary Part, p. 5f. – Ditto on facebook: [https://www.facebook.com/notes/hannes-mueller/the-legend-of-20000-nerve-endings/2034618236765662/ The legend of the “20,000 nerve endings]”:</ref> Nevertheless, this article identifies the origin and the calculation of these figures, explains how credible they are, and what magnitude range is the most realistic.
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A frequent argument against the non-therapeutic [[foreskin]] [[amputation]] is the concept that the [[foreskin]] not only contains numerous nerve endings and is more sensitive for touch than the [[Glans penis|glans]], but also that the number of nerve endings is “more than 10,000”, "(more than) 20,000" or even "up to 70,000" or “100,000”. There appears to be no reliable evidence for these figures.<ref name="Appendix">see Appendix: Documentary Part, p. 5f. – Ditto on facebook: [https://www.facebook.com/notes/hannes-mueller/the-legend-of-20000-nerve-endings/2034618236765662/ The legend of the “20,000 nerve endings]”:</ref> Nevertheless, this article identifies the origin and the calculation of these figures, explains how credible they are, and what magnitude range is the most realistic.
  
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The [[Intactivists]] movement, which promotes the idea that the possession of intact genitals is a [[human rights| human right]], is active against the genital mutilation of all children. [[Intactivists]] clarify many widespread myths about [[circumcision]], especially those concerned with male genital cutting. Advocates of circumcision often allege there are advantages. But the results of evidence-based scientific studies disprove these. They provide convincing arguments that the [[foreskin]] is not a superfluous piece of skin, but a part of the body with many positive functions and its lack leads to many disadvantages. To explain this, it is important to provide reliable, i.e. also verifiable, information about the anatomy of the [[foreskin]].
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The [[Intactivists]] movement, which promotes the idea that the possession of [[intact]] genitals is a [[human rights|human right]], is active against the genital mutilation of all children. [[Intactivists]] clarify many widespread myths about [[circumcision]], especially those concerned with male genital cutting. Advocates of [[circumcision]] often allege there are advantages. But the results of evidence-based scientific studies disprove these. They provide convincing arguments that the [[foreskin]] is not a superfluous piece of [[skin]], but a part of the body with many positive functions and its lack leads to many disadvantages. To explain this, it is important to provide reliable, i.e. also verifiable, information about the anatomy of the [[foreskin]].
  
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Medical studies of the past 25 years have provided much good evidence for [[intactivists]]. Evidence can be found, for example, that the [[foreskin]], especially at the end, is very densely supplied with nerve endings<ref name="Taylor">Taylor JR, Lockwood AP, Taylor AJ. [http://www.cirp.org/library/anatomy/taylor/The prepuce: specialized mucosa of the [[penis]] and its loss to circumcision]. ''Br J Urol'' 1996;77:291-295.</ref>, and is very sensitive to fine touch, even more sensitive than the [[Glans penis|glans]]<ref>{{Sorrells etal 2007}}</ref>. Basically this is enough to emphasize the special sensitivity of the [[foreskin]]. However, it is in this connection that the above figures are often quoted.
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Medical studies of the past 25 years have provided much good evidence for [[intactivists]]. Evidence can be found, for example, that the [[foreskin]], especially at the end, is very densely supplied with nerve endings<ref name="Taylor">{{TaylorJR LockwoodAP TaylorAJ 1996}}</ref>, and is very sensitive to fine touch, even more sensitive than the [[Glans penis|glans]]<ref>{{Sorrells etal 2007}}</ref>. Basically this is enough to emphasize the special sensitivity of the [[foreskin]]. However, it is in this connection that the above figures are often quoted.
  
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The traceable story of the legend of "20,000 nerve endings" began in October '''1997''', when the article "The Case Against Circumcision"<ref name="Fleiss">Fleiss, P. [http://www.cirp.org/news/Mothering1997/ The case against circumcision]. ''Mothering Magazine'' (Santa Fe). Winter 1997.</ref> by Paul Fleiss appeared in the popular mothers’ magazine “''Mothering''”. This is the first documentation of the ‘fact’, that the [[foreskin]] contains "more than 20,000 nerve endings". Fleiss referred to an article from 1932 by the English physiologist H. C. Bazett (1885-1950) together with other authors within a medical scientific journal.<ref name="bazett1932">Bazett HC, McGlone B, Willams RG, Lufkin HM. [http://www.cirp.org/library/anatomy/bazett/ I. Depth, distribution and probable identification in the prepuce of sensory end-organs concerned in sensations of temperature and touch thermo-metric conductivity]. ''Arch Neurol Psychiatry'' 1932;27(3):489-517.</ref>
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The traceable story of the legend of "20,000 nerve endings" began in October '''1997''', when the article "The Case Against Circumcision"<ref name="Fleiss">{{REFjournal
 +
|last=Fleiss
 +
|init=P
 +
|author-link=Paul M. Fleiss
 +
|url=http://www.cirp.org/news/Mothering1997/
 +
|title=The case against circumcision
 +
|journal=Mothering Magazine
 +
|location=Santa Fe
 +
|season?Winter
 +
|date=1997
 +
}}</ref> by Paul Fleiss appeared in the popular mothers’ magazine “''Mothering''”. This is the first documentation of the ‘fact’, that the [[foreskin]] contains "more than 20,000 nerve endings". Fleiss referred to an article from 1932 by the English physiologist H. C. Bazett (1885-1950) together with other authors within a medical scientific journal.<ref name="bazett1932">{{REFjournal
 +
|last=Bazett
 +
|init=HC
 +
|last2=McGlone
 +
|init2=B
 +
|last3=Willams
 +
|init3=RG
 +
|last4=Lufkin
 +
|init4=HM
 +
|url=http://www.cirp.org/library/anatomy/bazett/
 +
|title=I. Depth, distribution and probable identification in the prepuce of sensory end-organs concerned in sensations of temperature and touch thermo-metric conductivity
 +
|journal=Arch Neurol Psychiatry
 +
|date=1932
 +
|volume=27
 +
|issue=3
 +
|pages=489-517
 +
}}</ref>
  
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The popular American pediatrician [[Paul Fleiss]] (1933-2014), in empathy with the children, was very active against the genital mutilation of newborns by [[RIC]](non-therapeeutic) (Routine Infant Circumcision) in USA. Fleiss, [[Marilyn Milos|Marilyn F. Milos]], and alongside them many other [intactivist]] pioneers, have contributed enormously to explaining its negative consequences. Fleiss knew of the article by Bazett et al. (1932) through the medical historian F. Hodges. Fleiss and Hodges were well known to each other. They appeared both in the 1995 film “[[Whose Body, Whose Rights?]]”<ref name="WhoseBody">film "Whose Body, Whose Rights?" https://www.youtube.com/watch?v=W0kr6BiVZMM</ref>, and together they co-authored several articles<ref>Letter; Neonatal circumcision does not protect against penile cancer; [[foreskin]] IS NECESSARY; AIDS and circumcision; Circumcision in infancy; Authors’ reply; Immunological functions of the human prepuce</ref> and two books<ref name="SweetDreams">a) Sweet Dreams 2000; b) www.amazon.com/What-Your-Doctor-About-Circumcision/dp/0446678805 2002</ref>. In “The Case Against Circumcision” Fleiss referred to Hodges’ article: “A short history of circumcision in the United States” from Jan. 1997, wherein Hodges writes about Bazett’s “detailed anatomical description of the innervation of the [[foreskin]].”<ref>http://www.historyofcircumcision.net/index.php?option=com_content&task=view&id=90&Itemid=0: Fn 50</ref>
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The popular American pediatrician [[Paul Fleiss]] (1933-2014), in empathy with the children, was very active against the genital mutilation of newborns by [[RIC]](non-therapeeutic) (Routine Infant Circumcision) in USA. Fleiss, [[Marilyn Milos|Marilyn F. Milos]], and alongside them many other [intactivist]] pioneers, have contributed enormously to explaining its negative consequences. Fleiss knew of the article by Bazett et al. (1932) through the medical historian F. Hodges. Fleiss and Hodges were well known to each other. They appeared both in the 1995 film “[[Whose Body, Whose Rights?]]”<ref name="WhoseBody">{{REFweb
 +
|url=https://www.youtube.com/watch?v=W0kr6BiVZMM
 +
|title=film "Whose Body, Whose Rights?"
 +
|publisher=YouTube
 +
}}</ref>, and together they co-authored several articles<ref>Letter; Neonatal circumcision does not protect against penile cancer; [[foreskin]] IS NECESSARY; [[AIDS]] and circumcision; Circumcision in infancy; Authors’ reply; Immunological functions of the human prepuce</ref> and two books<ref name="SweetDreams">a) Sweet Dreams 2000; b) www.amazon.com/What-Your-Doctor-About-Circumcision/dp/0446678805 2002</ref>. In “The Case Against Circumcision” Fleiss referred to Hodges’ article: “A short history of circumcision in the United States” from Jan. 1997, wherein Hodges writes about Bazett’s “detailed anatomical description of the innervation of the [[foreskin]].”<ref>http://www.historyofcircumcision.net/index.php?option=com_content&task=view&id=90&Itemid=0: Fn 50</ref>
  
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The dissemination of Fleiss’ article took place through the Intactivist movement through [[NOCIRC]], [[Doctors Opposing Circumcision|DOC]], [[NOHARMM]], NRC and “[[Mothers Against Circumcision]]”, amongst others.<ref>http://www.nocirc.org/; http://www.doctorsopposingcircumcision.org/; http://www.noharmm.org/; http://childrightsnurses.org/; “For More Information”: http://www.mothersagainstcirc.org/fleiss.html</ref>
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The dissemination of Fleiss’ article took place through the Intactivist movement through [[NOCIRC]], [[Doctors Opposing Circumcision (D.O.C.)]]], [[NOHARMM]], NRC and “[[Mothers Against Circumcision]]”, amongst others.<ref>http://www.nocirc.org/; http://www.doctorsopposingcircumcision.org/; http://www.noharmm.org/; http://childrightsnurses.org/; “For More Information”: http://www.mothersagainstcirc.org/fleiss.html</ref>
  
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However, in the article by Bazett et al. (1932),<ref name ="bazett1932" /> no number is given for the nerve endings in the [[foreskin]] as a whole. Only a count of 212 nerve endings in a 1 cm² piece of a single prepuce tissue is given (see Table 1, p. 492). The 29-page Bazett article of 1932<ref name="bazett1932"/> to which Fleiss refers as a source for his "20,000", without mentioning the page, is only provided with "Conclusions" at CIRP: "For both technical reasons and perceived lack of general interest, CIRP will not present these parts and will only transcribe the conclusions."  – the entire article is available in the archive of "The JAMA Network"<ref name="JAMA">http://jamanetwork.com/journals/archneurpsyc/article-abstract/645191</ref>. The article may be available in 2019 but it was not available in the spring of 1997.
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However, in the article by Bazett et al. (1932),<ref name ="bazett1932" /> no number is given for the nerve endings in the [[foreskin]] as a whole. Only a count of 212 nerve endings in a 1 cm² piece of a single prepuce tissue is given (see Table 1, p. 492). The 29-page Bazett article of 1932<ref name="bazett1932"/> to which Fleiss refers as a source for his "20,000", without mentioning the page, is only provided with "Conclusions" at CIRP: "For both technical reasons and perceived lack of general interest, CIRP will not present these parts and will only transcribe the conclusions."  — the entire article is available in the archive of "The JAMA Network"<ref name="JAMA">http://jamanetwork.com/journals/archneurpsyc/article-abstract/645191</ref>. The article may be available in 2019 but it was not available in the spring of 1997.
  
 
=== How did Fleiss come to this number, which is nowhere documented? ===
 
=== How did Fleiss come to this number, which is nowhere documented? ===
  
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==== The number of nerve endings in normal skin ====
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==== The number of nerve endings in normal [[skin]] ====
  
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As early as 1971, the anthropologist [[Ashley Montagu]] (1905-1999) had written in a study on the importance of skin as a tactile organ for the social development of man: “A piece of skin the size of a quarter [25-US-cent piece] contains more than […] 50 nerve endings, […]”<ref>A. Montagu, Touching: The Human Significance of the Skin, 1971, <sup>2</sup>1978, p. 4; https://archive.org/stream/youchingthehuman000780mbp/youchingthehuman000780mbp_djvu.txt and 1979: http://www.foreskin.org/quarter.htm</ref>
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As early as 1971, the anthropologist [[Ashley Montagu]] (1905-1999) had written in a study on the importance of [[skin]] as a tactile organ for the social development of man: “A piece of [[skin]] the size of a quarter [25-US-cent piece] contains more than […] 50 nerve endings, […]”<ref>A. Montagu, Touching: The Human Significance of the Skin, 1971, <sup>2</sup>1978, p. 4; https://archive.org/stream/youchingthehuman000780mbp/youchingthehuman000780mbp_djvu.txt and 1979: http://www.foreskin.org/quarter.htm</ref>
  
 
==== The size of a [[foreskin]] ====
 
==== The size of a [[foreskin]] ====
  
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1992 (<sup>2</sup>1996) appeared in the small book "Say No to Circumcision" of [[Thomas J. Ritter|T.J. Ritter]] and [[George C. Denniston|G.C. Denniston]] ([[DOC|D.O.C.]]): "Circumcision removes a piece of skin (that in the adult is) almost equivalent to a 3 × 5 index card.”<ref name="galleryIntact">quoted in http://www.circumcisionharm.org/gallery%20intact.htm</ref> Thus, the [[foreskin]] size of an adult was given as 3×5 = 15 sq.inch = 96.8cm²<ref>https://www.15square.org.uk/ ("15 Square" = trade name of NORM-UK)</ref>, going out of about 1.5 inches = 3.81cm in length for inner and outer [[foreskin]] sheet and 5 inches = 12.7cm circumference. This too is found in Fleiss and Hodges, 2002<ref name="Fn11b">see Fn 9b, p. 4. Mistranslation in “Beschneidung-von-Jungen.de“: „ungefähr die Größe einer 4[!]x5 Zoll (also: 10x12,5cm) Karteikarte“ [but in the picture animation: “100cm²”]. → 125×212 = 26,500 nerve endings. http://archive.is/20130903162537/www.beschneidung-von-jungen.de/home/infos-fuer-eltern/was-ist-dievorhaut/ was-ist-die-vorhaut-anatomische-und-physiologische-fakten.html#selection-603.105-603.168</ref>. The length also is indicated to be about 4cm and the circumference 13cm, which leads to an area of 8×13=104 cm².<ref name="circumcisionharm">a) http://www.circumcisionharm.org/gallery%20intact.htm and b) http://noharmm.org/snip.htm</ref> Size-measuring studies give a maximum (not average!) area of 99.8 cm².<ref name="ForeskinSize">see: Werker et al. (1998) and Kigozi et al. (2009).</ref>
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1992 (<sup>2</sup>1996) appeared in the small book "Say No to Circumcision" of [[Thomas J. Ritter|T.J. Ritter]] and [[George C. Denniston|G.C. Denniston]] ([[DOC|D.O.C.]]): "Circumcision removes a piece of [[skin]] (that in the adult is) almost equivalent to a 3 × 5 index card.”<ref name="galleryIntact">{{REFweb
 +
|url=http://www.circumcisionharm.org/gallery%20intact.htm
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|title=Global Survey of Circumcision Harm
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|last=
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|first=
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|accessdate=2021-09-01
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}}quoted in </ref> Thus, the [[foreskin]] size of an adult was given as 3×5 = 15 sq.inch = 96.8cm²<ref>{{REFweb
 +
|url=https://www.15square.org.uk/
 +
|title=15Square
 +
|last=
 +
|first=
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|accessdate=2021-09-01
 +
}} ("15 Square" = trade name of NORM-UK)</ref>, going out of about 1.5 inches = 3.81cm in length for inner and outer [[foreskin]] sheet and 5 inches = 12.7cm circumference. This too is found in Fleiss and Hodges, 2002<ref name="Fn11b">see Fn 9b, p. 4. Mistranslation in “Beschneidung-von-Jungen.de“: „ungefähr die Größe einer 4[!]x5 Zoll (also: 10x12,5cm) Karteikarte“ [but in the picture animation: “100cm²”]. → 125×212 = 26,500 nerve endings. http://archive.is/20130903162537/www.beschneidung-von-jungen.de/home/infos-fuer-eltern/was-ist-dievorhaut/ was-ist-die-vorhaut-anatomische-und-physiologische-fakten.html#selection-603.105-603.168</ref>. The length also is indicated to be about 4cm and the circumference 13cm, which leads to an area of 8×13=104 cm².<ref name="circumcisionharm">a) http://www.circumcisionharm.org/gallery%20intact.htm and b) http://noharmm.org/snip.htm</ref> Size-measuring studies give a maximum (not average!) area of 99.8 cm².<ref name="ForeskinSize">see: Werker et al. (1998) and Kigozi et al. (2009).</ref>
  
 
==== Nerve endings in the [[foreskin]] / Quarter (25-US-Ct.) ====
 
==== Nerve endings in the [[foreskin]] / Quarter (25-US-Ct.) ====
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1995, in the film "[[Whose Body, Whose Rights?]]"<ref name="WhoseBody" /> starting from Montagu's description of the number of nerve endings in normal skin, the number of nerve endings in the [[foreskin]] was calculated as follows: “15 square inches comfortably fits 15 quarters. This analogy helps us to understand that the adult [[foreskin]] contains … over 1000 nerve endings …" (15 × more than 50 = more than 750), which NOHARMM supplements to "Since Dr. Taylor's research suggests that the [[foreskin]] is '''more densely enervated than "normal" skin''', a circumcised man likely loses many times more than 1,000 nerve endings.”<ref name="circumcisionharm" /><sup>b</sup>
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1995, in the film "[[Whose Body, Whose Rights?]]"<ref name="WhoseBody" /> starting from Montagu's description of the number of nerve endings in normal [[skin]], the number of nerve endings in the [[foreskin]] was calculated as follows: “15 square inches comfortably fits 15 quarters. This analogy helps us to understand that the adult [[foreskin]] contains … over 1000 nerve endings …" (15 × more than 50 = more than 750), which NOHARMM supplements to "Since Dr. Taylor's research suggests that the [[foreskin]] is '''more densely innervated than "normal" [[skin]]''', a [[circumcised]] man likely loses many times more than 1,000 nerve endings.”<ref name="circumcisionharm" /><sup>b</sup>
 +
 
 
==== The “ridged band" ====
 
==== The “ridged band" ====
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In 1996 the article by the Canadian pathologist [[John R. Taylor]] et al.<ref name="Taylor" /> about the “ridged band” of the [[foreskin]] had appeared. Taylor reported, that the encapsulated nerve endings<ref>Nerve endings can be divided into types with or without end corpuscles (corpuscular/encapsulated or free nerve endings). “… the free nerve endings (FNE) … do not seem to have any part in fine touch sensation (they are innervated by unmyelinated axons which conduct too slowly, don’t have specialised end corpuscles to transduce vibration, etc. and have a high threshold, all of which prevent the conduction of fine touch).” [[Ken McGrath|McGrath]], Fn 29b</ref> of the [[foreskin]] are concentrated in the “ridged band” and thus are distributed very differently. In his article, Fleiss also mentions the "ridged mucosa" and calls Taylor as a source. He therefore knew of Taylor’s work.
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In 1996 the article by the Canadian pathologist [[John R. Taylor]] et al.<ref name="Taylor" /> about the “ridged band” of the [[foreskin]] had appeared. Taylor reported, that the encapsulated nerve endings<ref>Nerve endings can be divided into types with or without end corpuscles (corpuscular/encapsulated or free nerve endings). “… the free nerve endings (FNE) … do not seem to have any part in fine touch sensation (they are innervated by unmyelinated axons which conduct too slowly, don’t have specialised end corpuscles to transduce vibration, etc. and have a high threshold, all of which prevent the conduction of fine touch).” [[Ken McGrath|McGrath]], Fn 29b</ref> of the [[foreskin]] are concentrated in the “ridged band” and thus are distributed very differently. In his article, Fleiss also mentions the "ridged [[mucosa]]" and calls Taylor as a source. He therefore knew of Taylor’s work.
 
==== Nerve endings in the [[foreskin]] / 1cm² ====
 
==== Nerve endings in the [[foreskin]] / 1cm² ====
 
In 1997 Fleiss knew from Bazett et al. (1932).<ref name="bazett1932" />,<ref name="JAMA" /> that they had counted 212 nerve endings within a 1cm²-piece of a single [[foreskin]] tissue (Table 1, p. 492). Now it is obvious that Fleiss reckoned similarly therewith and  with the [[foreskin]] size of 15 sq.inch = 96.8 cm² (or with 8×13 = 104 cm²): 96.8 cm²×212 nerve endings / cm² = 20,522 nerve endings (or 104×212 = 22,048; short: 100×>200= >20,000). So he obviously came to "more than 20,000 nerve endings".
 
In 1997 Fleiss knew from Bazett et al. (1932).<ref name="bazett1932" />,<ref name="JAMA" /> that they had counted 212 nerve endings within a 1cm²-piece of a single [[foreskin]] tissue (Table 1, p. 492). Now it is obvious that Fleiss reckoned similarly therewith and  with the [[foreskin]] size of 15 sq.inch = 96.8 cm² (or with 8×13 = 104 cm²): 96.8 cm²×212 nerve endings / cm² = 20,522 nerve endings (or 104×212 = 22,048; short: 100×>200= >20,000). So he obviously came to "more than 20,000 nerve endings".
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In '''2017''', [[Ken McGrath]] confirms his estimate from 1998<ref>McGrath’s statement in a contribution to a yet unpublished book (emphasis from author), made available to the author by forwarded email from L.R. Watson to [[Ulf Dunkel]] on May 31, 2017.</ref>:
 
In '''2017''', [[Ken McGrath]] confirms his estimate from 1998<ref>McGrath’s statement in a contribution to a yet unpublished book (emphasis from author), made available to the author by forwarded email from L.R. Watson to [[Ulf Dunkel]] on May 31, 2017.</ref>:
 
{{Citation
 
{{Citation
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| Text=The following method has been used to estimate the number of corpuscular nerve endings in the [[foreskin]]. The frenular delta and frenular band are more sensitive than a fingertip; one square centimetre of fingertip has about 30-40 ridges with approximately three [[Meissner's corpuscles]] in every millimetre of ridge. For each centimetre of ridge there would be thirty [[Meissner's corpuscles]] and thus 900-1200 per cm2 of tip. The area of the frenular delta is equivalent to or greater than three fingertip areas, i.e. about 3-4 cm2. Therefore, at a minimum, the most sensitive area of the prepuce would have at least 3000 corpuscular endings. In orders of magnitude, the number has to be more than 1000 and less than 10,000. Some writers have erroneously inflated this estimate to 20,000 or more. More research is needed to clarify the actual number and distribution.
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|Text=The following method has been used to estimate the number of corpuscular nerve endings in the [[foreskin]]. The frenular delta and frenular band are more sensitive than a fingertip; one square centimetre of fingertip has about 30-40 ridges with approximately three [[Meissner's corpuscles]] in every millimetre of ridge. For each centimetre of ridge there would be thirty [[Meissner's corpuscles]] and thus 900-1200 per cm2 of tip. The area of the frenular delta is equivalent to or greater than three fingertip areas, i.e. about 3-4 cm2. Therefore, at a minimum, the most sensitive area of the prepuce would have at least 3000 corpuscular endings. In orders of magnitude, the number has to be more than 1000 and less than 10,000. Some writers have erroneously inflated this estimate to 20,000 or more. More research is needed to clarify the actual number and distribution.
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| Author=[[Ken McGrath]]
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|Author=[[Ken McGrath]]
 
}}
 
}}
 +
 
And in a further actual statement about the 20,000 figure [[Ken McGrath|McGrath]] writes:
 
And in a further actual statement about the 20,000 figure [[Ken McGrath|McGrath]] writes:
  
 
{{Citation
 
{{Citation
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| Text=[…] it is impossible for the [[foreskin]] to support such a huge number: there is not enough surface area to mount so many receptors (they would nearly outnumber the epithelial cells!) and the known number of axons ranging into the prepuce could not connect to that number. Furthermore, such a vast number is totally unnecessary to achieve the known high sensitivity of the prepuce.
+
|Text=[…] it is impossible for the [[foreskin]] to support such a huge number: there is not enough surface area to mount so many receptors (they would nearly outnumber the epithelial cells!) and the known number of axons ranging into the prepuce could not connect to that number. Furthermore, such a vast number is totally unnecessary to achieve the known high sensitivity of the prepuce.
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| Author=[[Ken McGrath]]
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|Author=[[Ken McGrath]]
−
| <ref>a.) quoted after [[Ken McGrath|McGrath]], Fn 27a; b.)</ref>
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|<ref>a.) quoted after [[Ken McGrath|McGrath]], Fn 27a; b.)</ref>
 
}}
 
}}
 
   
 
   
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{{Citation
 
{{Citation
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| Text=I made my estimate at the Symposium held in Oxford UK, Summer 1998. … I made my informal ‘back of the envelope’ estimation in response to a question during discussion outside the meeting. … Paul Fleiss did not differentiate between the types [of nerve endings] either and simply took Bazett's total number for his estimate.  
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|Text=I made my estimate at the Symposium held in Oxford UK, Summer 1998. … I made my informal ‘back of the envelope’ estimation in response to a question during discussion outside the meeting. … Paul Fleiss did not differentiate between the types [of nerve endings] either and simply took Bazett's total number for his estimate. <br><br>
−
 
+
In my estimation, I extrapolated the numbers of [[Meissner's corpuscles|Meissner corpuscular endings]] from the finger tip to the prepuce as these are the principal mediators of fine touch (and, therefore, of sexual sensation). All [[skin]] appears to have many free nerve endings evenly distributed over their surfaces regardless of the local function; two epithelia, however, have virtually no fine touch—the cornea of the eye and the [[Glans penis|glans penis]]—having almost nothing but free nerve endings. The prepuce is no exception to this general pattern of having FNE over its entire surface, but like most other [[skin]] (except the two exceptions above) it has varying numbers and distribution of corpuscular endings which are in lower numbers than the FNE. From teaching [[skin]] enervation to medical students using sections of an index finger, I knew the numbers of [[Meissner's corpuscles]] in that [[skin]]. Observation and personal experience told me that the prepuce was more sensitive than the finger tips which suggested there are more of those fine touch endings in the prepuce. But I could not be definite about the numbers in the prepuce having only looked at some general sections. So I made an estimate in orders of magnitude: not less than 1000 nor more than 10,000 with the view that the numbers were probably at the lower end; i.e. between 1000 and 2000. Some recent work seems to confirm a figure around 1500.
−
In my estimation, I extrapolated the numbers of [[[[Meissner's corpuscles|Meissner corpuscular endings]] from the finger tip to the prepuce as these are the principal mediators of fine touch (and, therefore, of sexual sensation). All skin appears to have many free nerve endings evenly distributed over their surfaces regardless of the local function; two epithelia, however, have virtually no fine touch—the cornea of the eye and the [[Glans penis|glans penis]]—having almost nothing but free nerve endings. The prepuce is no exception to this general pattern of having FNE over its entire surface, but like most other skin (except the two exceptions above) it has varying numbers and distribution of corpuscular endings which are in lower numbers than the FNE. From teaching skin enervation to medical students using sections of an index finger, I knew the numbers of [[Meissner's corpuscles]] in that skin. Observation and personal experience told me that the prepuce was more sensitive than the finger tips which suggested there are more of those fine touch endings in the prepuce. But I could not be definite about the numbers in the prepuce having only looked at some general sections. So I made an estimate in orders of magnitude: not less than 1000 nor more than 10,000 with the view that the numbers were probably at the lower end; i.e. between 1000 and 2000. Some recent work seems to confirm a figure around 1500.
+
|Author=[[Ken McGrath]]
−
| Author=[[Ken McGrath]]
 
 
}}
 
}}
  
 
=== A purely quantitative consideration for plausibility speaking against “20,000 nerve endings” in the [[foreskin]] ===
 
=== A purely quantitative consideration for plausibility speaking against “20,000 nerve endings” in the [[foreskin]] ===
  
−
The genital tissue by male and woman is probably not so far different. The difference is mainly in the form and the nerve endings are differently distributed in detail, but on the whole their number maybe nearly equal. The [[Glans penis|glans]] of the [[penis]] may have 4k and the clitoris 8k. If the [[foreskin]] for instance has 10k, then the number of nerve endings in the whole would be 14k, so that the non-clitoridal genital has 6k, with the same total number in men and women. If the [[foreskin]] has 12k, then there is 16k together with the [[Glans penis|glans]], and the non-clitoridal genital has the same as the clitoris: each 8k. If the female non-clitoidal genital has less than the clitoris, for example max. 6k, ie together max. 14k, then stays for the [[foreskin]] max. 10k. – Gender equality seems possible: for the whole 12k, clitoris or [[foreskin]] 8k, non-clitoridal genital or [[Glans penis|glans]] 4k.
+
The genital tissue by male and woman is probably not so far different. The difference is mainly in the form and the nerve endings are differently distributed in detail, but on the whole their number maybe nearly equal. The [[Glans penis|glans]] of the [[penis]] may have 4k and the [[clitoris]] 8k. If the [[foreskin]] for instance has 10k, then the number of nerve endings in the whole would be 14k, so that the non-clitoridal genital has 6k, with the same total number in men and women. If the [[foreskin]] has 12k, then there is 16k together with the [[Glans penis|glans]], and the non-clitoridal genital has the same as the [[clitoris]]: each 8k. If the female non-clitoidal genital has less than the [[clitoris]], for example max. 6k, ie together max. 14k, then stays for the [[foreskin]] max. 10k. – Gender equality seems possible: for the whole 12k, [[clitoris]] or [[foreskin]] 8k, non-clitoridal genital or [[Glans penis|glans]] 4k.
  
 
=== Conclusion ===
 
=== Conclusion ===
−
It is time to take leave of the exaggerated number of 20,000 nerve endings in the [[foreskin]].<ref>If you want to name a number, you should only specify the order of magnitude >3,000 <10,000. The number of nerve endings in the [[foreskin]] is probably at least 4,000, since the [[Glans penis|glans]] already has 4,000 and the [[foreskin]] is more sensitive – but this is not qualitatively differentiated, for instance between sensitivity to pain or touch.</ref> This legend is very wide spread by the opponents of circumcision. As long as the number cannot be scientifically proven, it is sufficient to say that the prepuce is very densely innervated and for fine touch is more sensitive than the [[Glans penis|glans]]<ref name="Approvals" />,<ref name="Appendix" />. Otherwise, the credibility and persuasive power of the Intactivist movement suffers and makes itself unnecessarily vulnerable. Unfortunately, this can also be seen on the Internet.
+
It is time to take leave of the exaggerated number of 20,000 nerve endings in the [[foreskin]].<ref>If you want to name a number, you should only specify the order of magnitude >3,000 <10,000. The number of nerve endings in the [[foreskin]] is probably at least 4,000, since the [[Glans penis|glans]] already has 4,000 and the [[foreskin]] is more sensitive — but this is not qualitatively differentiated, for instance between sensitivity to [[pain]] or touch.</ref> This legend is very wide spread by the opponents of [[circumcision]]. As long as the number cannot be scientifically proven, it is sufficient to say that the prepuce is very densely innervated and for fine touch is more sensitive than the [[Glans penis|glans]]<ref name="Approvals" /> <ref name="Appendix" />. Otherwise, the credibility and persuasive power of the [[Intactivist]] movement suffers and makes itself unnecessarily vulnerable. Unfortunately, this can also be seen on the Internet.
  
 
Statements on [[foreskin]] anatomy should be evidence-based on studies published in scientific journals, to keep them verifiable and comprehensible. This should be taken seriously. Publications containing the 20,000 (or 10,000 and more) legend should no longer be disseminated. We should make sure our articles are accurate and add correcting notes to published articles where possible.
 
Statements on [[foreskin]] anatomy should be evidence-based on studies published in scientific journals, to keep them verifiable and comprehensible. This should be taken seriously. Publications containing the 20,000 (or 10,000 and more) legend should no longer be disseminated. We should make sure our articles are accurate and add correcting notes to published articles where possible.
  
 
{{Citation
 
{{Citation
−
| Text=If you make a mistake and do not correct it, this is called a mistake
+
|Text=If you make a mistake and do not correct it, this is called a mistake.
−
| Author=Konfuzius
+
|Author=Confucius
 
}}
 
}}
  
 +
[[Paul M. Fleiss| Dr. Fleiss]], however, is no longer with us, so no explanation or correction may be expected from him. It is likely that when he prepared the article for publication in the popular press in 1997, he simply meant to informally express the concept of a [[Ridged band| very substantial innervation of the foreskin]] as had been previously reported by [[John R. Taylor| Taylor]] et al.<ref name="taylor1996">{{TaylorJR LockwoodAP TaylorAJ 1996}}</ref>
 
----
 
----
  
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  |accessdate=2021-08-31
 
  |accessdate=2021-08-31
 
}}</ref>
 
}}</ref>
 +
 +
: {{NOTE}} IntactiWiki has updated the relevant text to "The [[foreskin]] contains '''very many''' nerve endings ..." since then.
  
 
* '''[[PflegeWiki]]''': "And more than 20,000 nerve endings are irreversibly removed."<ref>{{REFweb
 
* '''[[PflegeWiki]]''': "And more than 20,000 nerve endings are irreversibly removed."<ref>{{REFweb
Line 168: Line 214:
 
  |first=
 
  |first=
 
  |accessdate=
 
  |accessdate=
−
}}</ref> - In the link to Bazett ''et al'' there is not such a number.
+
}}</ref> - In the link to Bazett et al. there is no such number.
  
 
* Book of [[Matthias Franz|M. Franz]]: '''„Die Beschneidung von Jungen – Ein trauriges Vermächtnis“''': Even there it is without proof: "it [the [[foreskin]]] has around 20,000 nerve endings, ..." - The reference to Hartman 2012 contains no number and the on Jaermann 2010 gives "over 1000": '''Scheinfeld''' in [[Matthias Franz|M. Franz]], Die Beschneidung von Jungen, 2014, p. 364
 
* Book of [[Matthias Franz|M. Franz]]: '''„Die Beschneidung von Jungen – Ein trauriges Vermächtnis“''': Even there it is without proof: "it [the [[foreskin]]] has around 20,000 nerve endings, ..." - The reference to Hartman 2012 contains no number and the on Jaermann 2010 gives "over 1000": '''Scheinfeld''' in [[Matthias Franz|M. Franz]], Die Beschneidung von Jungen, 2014, p. 364
Line 176: Line 222:
 
* '''[[beschneidung-von-jungen.de]]:'''
 
* '''[[beschneidung-von-jungen.de]]:'''
  
−
# "The [[foreskin]] contains 10,000 to 20,000 so-called specialized nerve endings of different types, ..."<ref>https://www.beschneidung-von-jungen.de/home/beschneidung-und-sexualitaet.html</ref> – not documented (not with Sorrel, [[Ken McGrath|McGrath]], Taylor, who only report more sensitivity than the [[Glans penis|glans]] from highly innervated tissue).
+
# "The [[foreskin]] contains 10,000 to 20,000 so-called specialized nerve endings of different types, ..."<ref>{{REFweb
−
# " … a circumcised man actually loses many more than 1000 nerve endings. (About 20000 nerveendings)."<ref>https://www.beschneidung-von-jungen.de/home/medizinisches-grundwissen/anatomie-und-funktion-der-vorhaut/anatomie-und-ondere-komponenten-der-vorhaut/kleiner-schnitt.html</ref> - From the indicated source (Montagu A., Matson F. The Human Connection, NY: McGraw Hill, 1979), no 20,000 can be derived as the number of nerve endings. - The quoted quote is also incomplete: "15 U.S. quarters" are translated with "25-US-Cent coins" without the "15".<ref>See: http://webcache.googleusercontent.com/search?q=cache:jfxXKByh1GQJ:www.noharmm.org/snip.htm+&cd=5&hl=de&ct=clnk&gl=de</ref>
+
|url=https://www.beschneidung-von-jungen.de/home/beschneidung-und-sexualitaet.html
−
# "Careful anatomical studies have shown that through circumcision [...] more than 70 m of nerves, and more than 20,000 nerve endings are lost."<ref>https://www.beschneidung-von-jungen.de/home/wichtige-trendumkehr-in-den-usa/wieso-schadet-die-beschneidung.html</ref> – The indicated source<ref>http://www.cirp.org/library/anatomy/bazett/ (THE CIRCUMCISION REFERENCE LIBRARY. ARCHIVES OF NEUROLOGY AND PSYCHIATRY, Vol. 27, Number 3: Pages 489-517, March 1932.)</ref> provides only "Conclusions". The number 20,000 did not appear until 1997 (see below).
+
|title=Beschneidung und Sexualität
−
# "Physical effects of circumcision. [[John Warren]], Royal College of Physicians, London, UK; NORM-UK, Staffordshire, UK; Excerpt ... loss of at least 10000 to 20000 specialized erotogenic nerve endings, .... [...] It was calculated that at least 10000 -20000 specialized erotegenic nerve endings are removed during circumcision. (Winkelmann, 1959, 1956)."<ref>https://www.beschneidung-von-jungen.de/home/argumente-gegen-beschneidung/nachteile-der-beschneidung.html</ref> And: "Graphics added later [!]. ... Citations of the English original article: Warren J. Physical Effects of Circumcision. In: Denniston GC, Milos MF, Hodges FM (eds.). Genital Autonomy: Protecting Personal Choice. Heidelberg, New York: Springer; 2010. p. 75-79." – But there is no calculation. “20,000” in the graphic is without proof.
+
|last=
−
# "Infos for Parents: What is the [[foreskin]]":<ref>http://webcache.googleusercontent.com/search?q=cache:iiQtHltjyG8J:thecircumcisiondecision.com/20000-nerve-endings/+&cd=1&hl=de&ct=clnk&gl=de</ref> "What is the [[foreskin]]? Anatomical and physiological facts of Dr. med. Paul M. Fleiss and Dr. phil. Frederick Hodges [...] In fact, the [[foreskin]] contains more than 70 meters of nerve fibers and tens of thousands of specialized erotogenic [...] nerve endings ... "<ref>https://www.beschneidung-von-jungen.de/home/infos-fuereltern/was-ist-die-vorhaut/was-ist-die-vorhaut-anatomische-and-physiological-fakten.html</ref> (graphic like above) "Citation of the English original text: Fleiss, Paul M; Hodges, Frederick. What Your Doctor May Not Tell You About Circumcision. New York: Warner Books; C2002. Chapter 1, What is the [[foreskin]]. Anatomical facts, that your doctor may not know; p. 1-17." <br />'''This text<ref>https://www.amazon.com/What-Your-Doctor-About-Circumcision/dp/0446678805#reader_0446678805 p. 2f.</ref> by Fleiss and Hodges and an earlier article by Fleiss<ref name="Fleiss /> in 1997 seem to be the source of the greatly exaggerated misleading vacant figure of 20,000.'''
+
|first=
 +
|accessdate=2021-09-01
 +
}}</ref> – not documented (not with Sorrel, [[Ken McGrath|McGrath]], Taylor, who only report more sensitivity than the [[Glans penis|glans]] from highly innervated tissue).
 +
# " … a circumcised man actually loses many more than 1000 nerve endings. (About 20,000 nerveendings)."<ref>{{REFweb
 +
|url=https://www.beschneidung-von-jungen.de/home/medizinisches-grundwissen/anatomie-und-funktion-der-vorhaut/anatomie-und-ondere-komponenten-der-vorhaut/kleiner-schnitt.html
 +
|title=Der Penis und die Vorhaut: Die Anatomie der Vorhaut und ihre sexuelle Funktion
 +
|last=
 +
|first=
 +
|accessdate=2021-09-01
 +
}}</ref> - From the indicated source (Montagu A., Matson F. The Human Connection, NY: McGraw Hill, 1979), no 20,000 can be derived as the number of nerve endings. - The quoted quote is also incomplete: "15 U.S. quarters" are translated with "25-US-Cent coins" without the "15".<ref>See: http://webcache.googleusercontent.com/search?q=cache:jfxXKByh1GQJ:www.noharmm.org/snip.htm+&cd=5&hl=de&ct=clnk&gl=de</ref>
 +
# "Careful anatomical studies have shown that through circumcision [...] more than 70 m of nerves, and more than 20,000 nerve endings are lost."<ref>https://www.beschneidung-von-jungen.de/home/wichtige-trendumkehr-in-den-usa/wieso-schadet-die-beschneidung.html</ref> – The indicated source<ref>{{REFweb
 +
|url=http://www.cirp.org/library/anatomy/bazett/
 +
|title=I. Depth, distribution and probable identification in the prepuce of sensory end-organs concerned in sensations of temperature and touch thermometric conductivity
 +
|last=Bazett
 +
|first=HC
 +
|date=1932-03
 +
|accessdate=2021-09-01
 +
}} (THE CIRCUMCISION REFERENCE LIBRARY. ARCHIVES OF NEUROLOGY AND PSYCHIATRY, Vol. 27, Number 3: Pages 489-517, March 1932.)</ref> provides only "Conclusions". The number 20,000 did not appear until 1997 (see below).
 +
# "Physical effects of circumcision. [[John Warren]], Royal College of Physicians, London, UK; NORM-UK, Staffordshire, UK; Excerpt ... loss of at least 10000 to 20000 specialized erotogenic nerve endings, .... [...] It was calculated that at least 10000 -20000 specialized erotegenic nerve endings are removed during circumcision. (Winkelmann, 1959, 1956)."<ref>{{REFweb
 +
|url=https://www.beschneidung-von-jungen.de/home/argumente-gegen-beschneidung/nachteile-der-beschneidung.html
 +
|title=Körperliche Auswirkungen der Beschneidung
 +
|last=Warren
 +
|first=John
 +
|accessdate=2021-09-01
 +
}}</ref> And: "Graphics added later [!]. ... Citations of the English original article: Warren J. Physical Effects of Circumcision. In: Denniston GC, Milos MF, Hodges FM (eds.). Genital Autonomy: Protecting Personal Choice. Heidelberg, New York: Springer; 2010. p. 75-79." – But there is no calculation. “20,000” in the graphic is without proof.
 +
# "Infos for Parents: What is the [[foreskin]]": "What is the [[foreskin]]? Anatomical and physiological facts of Dr. med. Paul M. Fleiss and Dr. Phil. Frederick Hodges [...] In fact, the [[foreskin]] contains more than 70 meters of nerve fibers and tens of thousands of specialized erotogenic [...] nerve endings ... "<ref>https://www.beschneidung-von-jungen.de/home/infos-fuereltern/was-ist-die-vorhaut/was-ist-die-vorhaut-anatomische-and-physiological-fakten.html</ref> (graphic like above) "Citation of the English original text: Fleiss, Paul M; Hodges, Frederick. What Your Doctor May Not Tell You About Circumcision. New York: Warner Books; C2002. Chapter 1, What is the [[foreskin]]. Anatomical facts, that your doctor may not know; p. 1-17." <br />'''This text<ref>{{REFweb
 +
|url=https://www.amazon.com/What-Your-Doctor-About-Circumcision/dp/0446678805#reader_0446678805
 +
|title=What your doctor may not tell you about circumcision
 +
|last=
 +
|first=
 +
|accessdate=2021-09-01
 +
}} p. 2f.</ref> by Fleiss and Hodges and an earlier article by Fleiss<ref name="Fleiss /> in 1997 seem to be the source of the greatly exaggerated misleading vacant figure of 20,000.'''
  
 
* In the '''[[beschneidungsforum.de|Circumcision Forum]]''', the assertion of the "20,000 nerve endings" is spread without proof:
 
* In the '''[[beschneidungsforum.de|Circumcision Forum]]''', the assertion of the "20,000 nerve endings" is spread without proof:
Line 189: Line 266:
 
# https://www.beschneidungsforum.de/index.php/Thread/5259-Unprofessioneller-Journalismus-wie-swissmom-ch-junge-M%C3%BCtter-%C3%BCber-den-Penis-und-d/?postID=37698&highlight=10000%2BNervenenden#post37698 („NOHARMM knows“) Even NOHARMM does not know, but copies only what is not prooved: “The [[foreskin]] contains branches of the dorsal nerve and between 10,000 and 20,000 specialized erotogenic nerve endings … from a list compiled by Gary L. Harryman (NORM/Southern California)”<ref>http://www.noharmm.org/advantage.htm</ref> – Specified sources do not provide any proof! (See: https://www.beschneidung-von-jungen.de/home/infos-fuer-eltern/was-durch-die-beschneidung-verlorengeht.html : "Gary L. Harryman, February 14, 1999")
 
# https://www.beschneidungsforum.de/index.php/Thread/5259-Unprofessioneller-Journalismus-wie-swissmom-ch-junge-M%C3%BCtter-%C3%BCber-den-Penis-und-d/?postID=37698&highlight=10000%2BNervenenden#post37698 („NOHARMM knows“) Even NOHARMM does not know, but copies only what is not prooved: “The [[foreskin]] contains branches of the dorsal nerve and between 10,000 and 20,000 specialized erotogenic nerve endings … from a list compiled by Gary L. Harryman (NORM/Southern California)”<ref>http://www.noharmm.org/advantage.htm</ref> – Specified sources do not provide any proof! (See: https://www.beschneidung-von-jungen.de/home/infos-fuer-eltern/was-durch-die-beschneidung-verlorengeht.html : "Gary L. Harryman, February 14, 1999")
 
# https://www.beschneidungsforum.de/index.php/Thread/4807-Gibt-es-eine-Bescheidungs-Methode-ohne-schmerzen-wenn-die-Vorhaut-abgeschn%C3%BCrt-wi/?postID=33736&highlight=10000%2BNervenenden#post33736 : "Loss of 10,000 to 20,000 nerve endings"
 
# https://www.beschneidungsforum.de/index.php/Thread/4807-Gibt-es-eine-Bescheidungs-Methode-ohne-schmerzen-wenn-die-Vorhaut-abgeschn%C3%BCrt-wi/?postID=33736&highlight=10000%2BNervenenden#post33736 : "Loss of 10,000 to 20,000 nerve endings"
−
# https://www.beschneidungsforum.de/index.php/Thread/1660-Erkl%C3%A4rung-von-Volker-Beck-et-al/?postID=10717&highlight=20000%2BNervenenden#post10717 : "The clipping of a clitoral [[foreskin]] is not comparable with amputating the entire [[penis]] [[foreskin]]. Clear: The entire clitoris including [[foreskin]] has only 8000 nerve endings, the male [[foreskin]] alone but 20000. Therefore, this is not comparable. Already confusing." Such a confusing misfortune then comes out as a result of the phantased "20,000".
+
# https://www.beschneidungsforum.de/index.php/Thread/1660-Erkl%C3%A4rung-von-Volker-Beck-et-al/?postID=10717&highlight=20000%2BNervenenden#post10717 : "The clipping of a clitoral [[foreskin]] is not comparable with amputating the entire [[penis]] [[foreskin]]. Clear: The entire [[clitoris]] including [[foreskin]] has only 8000 nerve endings, the male [[foreskin]] alone but 20000. Therefore, this is not comparable. Already confusing." Such a confusing misfortune then comes out as a result of the phantased "20,000".
 
# https://www.beschneidungsforum.de/index.php/Thread/4649-England-Why-the-UK-has-no-moral-right-to-tell-Africans-to-stop-genital-mutilatio/?postID=32474&highlight=20000#post32474 : "The [up to 20,000 nerve endings] is by the way an urban legend. There are about 10,000 cells. No one knows where the 20,000 come from. I think this is only a quotation and nowhere with source." (G.) "10,000 to 20,000" noharmm.org/advantage.htm The "urban legend" probably originates from Fleiss, P.M. (1997) The case against circumcision. ''Mothering'', Winter, 36-45 (see below)
 
# https://www.beschneidungsforum.de/index.php/Thread/4649-England-Why-the-UK-has-no-moral-right-to-tell-Africans-to-stop-genital-mutilatio/?postID=32474&highlight=20000#post32474 : "The [up to 20,000 nerve endings] is by the way an urban legend. There are about 10,000 cells. No one knows where the 20,000 come from. I think this is only a quotation and nowhere with source." (G.) "10,000 to 20,000" noharmm.org/advantage.htm The "urban legend" probably originates from Fleiss, P.M. (1997) The case against circumcision. ''Mothering'', Winter, 36-45 (see below)
  
−
* '''FB page of the circumcision forum''': <ref>https://www.facebook.com/beschneidungsforum.de/posts/1785501095046354</ref> It accepts here the page with the empty claim of the "20,000 nerve endings" from the "DocCheck Flexikon"<ref>http://flexikon.doccheck.com/de/Sexuelle_Auswirkungen_der_Zirkumzision (only German version)</ref>: “On average, the [[foreskin]] has about 73m of nerve fibers around 20000 mostly specialized nerve endings ..."
+
* '''FB page of the circumcision forum''': <ref>https://www.facebook.com/beschneidungsforum.de/posts/1785501095046354</ref> It accepts here the page with the empty claim of the "20,000 nerve endings" from the "DocCheck Flexikon"<ref>{{REFweb
 +
|url=http://flexikon.doccheck.com/de/Sexuelle_Auswirkungen_der_Zirkumzision
 +
|archived=
 +
|title=Sexuelle Auswirkungen der Zirkumzision
 +
|trans-title=
 +
|language=German
 +
|last=Fink
 +
|first=Bijan
 +
|author-link=
 +
|publisher=Einfach Eintauchen
 +
|website=DocCheck
 +
|date=
 +
|accessdate=2021-09-03
 +
|format=
 +
|quote=
 +
}} (only German version)</ref>: “On average, the [[foreskin]] has about 73m of nerve fibers around 20000 mostly specialized nerve endings ..."
  
−
* '''[[Ken McGrath]]''' (Email 5.7.2013 to Stephen Moreton PhD): “No one since about 1923 has published a count of neural receptors in the human [[penis]]. At a conference (1998 in Oxford I think) a group asked me to make an estimate of the number of nerve endings in the prepuce. I did a quick back-of-the-envelope guesstimate based on a fingertip and arrived at an orders of magnitude figure of >1000<10000. … this figure quickly inflated, first to >10,000 and then to >20,000; neither of these is anywhere near the truth, because they are an order of magnitude too high.” (emphasis from the author) http://circfacts.org/sensitivity/
+
* '''[[Ken McGrath]]''' (Email 5.7.2013 to Stephen Moreton {{PhD}}): “No one since about 1923 has published a count of neural receptors in the human [[penis]]. At a conference (1998 in Oxford I think) a group asked me to make an estimate of the number of nerve endings in the prepuce. I did a quick back-of-the-envelope guesstimate based on a fingertip and arrived at an orders of magnitude figure of >1000<10000. … this figure quickly inflated, first to >10,000 and then to >20,000; neither of these is anywhere near the truth, because they are an order of magnitude too high.” (emphasis from the author) http://circfacts.org/sensitivity/
  
 
* '''Moreton''': “Unlike 10,000, this one [20,000] has a printed source, though not a credible scientific one. It originated in an article that is still influential amongst intactivists to this day, by the late osteopath Paul Fleiss, published in “Mothering: the magazine of natural family living” (Fleiss, 1997).”
 
* '''Moreton''': “Unlike 10,000, this one [20,000] has a printed source, though not a credible scientific one. It originated in an article that is still influential amongst intactivists to this day, by the late osteopath Paul Fleiss, published in “Mothering: the magazine of natural family living” (Fleiss, 1997).”
  
−
* '''Fleiss on [[Mothers Against Circumcision|MothersAgainstCirc.org]]'''<ref>http://www.mothersagainstcirc.org/fleiss.html</ref>: The Case Against Circumcision, Paul M. Fleiss, 1997: “Circumcision denudes: … circumcision cuts off … 240 feet of nerves, and more than 20,000 nerve endings. [H. C. Bazett et al., "Depth, Distribution and Probable Identification in the Prepuce of Sensory End-Organs Concerned in Sensations of Temperature and Touch; Thermometric Conductivity," Archives of Neurology and Psychiatry 27 (1932): 489-517]” - There is no proof for "20,000"!
+
* '''Fleiss on [[Mothers Against Circumcision|MothersAgainstCirc.org]]'''<ref>{{REFweb
 +
|url=http://www.mothersagainstcirc.org/fleiss.html
 +
|title=The case against circumcision
 +
|last=Fleiss
 +
|first=Paul
 +
|date=1997
 +
|accessdate=2021-09-02
 +
}}</ref>: The Case Against Circumcision, Paul M. Fleiss, 1997: “Circumcision denudes: … circumcision cuts off … 240 feet of nerves, and more than 20,000 nerve endings. [H. C. Bazett et al., "Depth, Distribution and Probable Identification in the Prepuce of Sensory End-Organs Concerned in Sensations of Temperature and Touch; Thermometric Conductivity," ''Archives of Neurology and Psychiatry'' 27 (1932): 489-517]” - There is no proof for "20,000"!
  
 
=== Approvals to the first publication by e-mail to the author ===
 
=== Approvals to the first publication by e-mail to the author ===
Line 205: Line 304:
 
* [[Lindsay R. Watson]] (author and editor of „[[Unspeakable Mutilations]] – Circumcised Men Speak Out“, New Zealand)
 
* [[Lindsay R. Watson]] (author and editor of „[[Unspeakable Mutilations]] – Circumcised Men Speak Out“, New Zealand)
 
* [[Ken McGrath]] (Senior Lecturer in Pathology and Anatomy, retired, New Zealand)
 
* [[Ken McGrath]] (Senior Lecturer in Pathology and Anatomy, retired, New Zealand)
−
* [[Robert Darby]] (medical historian, New Zealand)  
+
* [[Robert Darby]] (medical historian, Australia)  
 
* [[Brian Earp|Brian D. Earp]] (medical ethicist, Oxford)  
 
* [[Brian Earp|Brian D. Earp]] (medical ethicist, Oxford)  
 
* [[Christoph Kupferschmid]] ([[BVKJ|Federal Association of Paediatricians]], Germany)
 
* [[Christoph Kupferschmid]] ([[BVKJ|Federal Association of Paediatricians]], Germany)
−
* [[Morten Frisch]] (Sexologist, main author of the AAP replica, Copenhagen)<ref>On 12.10.2017 the German and English first version of the article were posted with an accompanying text on Facebook: https://www.facebook.com/groups/248240545511361/534302533571862/. Morten Frisch shared and linked the article on Facebook on 28.10.2017 and wrote a post in which he called to mention no exaggerated numbers, thanked the author and recommended reading the article. He then received 93 likes, including 89 from Denmark, Marilyn F. Milos, Lloyd Schofield (president of Bay Area Intactivists), Brian D. Earp and Georg Zimmermann (University of Osnabrück, formerly human rights activist at intactivism); please refer: https://www.facebook.com/morten.frisch/posts/10214297927219433?pnref=story .</ref>
+
* [[Morten Frisch]] (Sexologist, main author of the AAP replica, Copenhagen)<ref>On 12.10.2017 the German and English first version of the article were posted with an accompanying text on Facebook: https://www.facebook.com/groups/248240545511361/534302533571862/. Morten Frisch shared and linked the article on Facebook on 28.10.2017 and wrote a post in which he called to mention no exaggerated numbers, thanked the author and recommended reading the article. He then received 93 likes, including 89 from [[Denmark]], Marilyn F. Milos, Lloyd Schofield (president of Bay Area Intactivists), Brian D. Earp and Georg Zimmermann ({{UNI|University of Osnabrück|UOS}}, formerly [[human rights]] activist at intactivism); please refer: https://www.facebook.com/morten.frisch/posts/10214297927219433?pnref=story .</ref>
 
* [[Victor Schonfeld]] (Filmmaker, documentation „[[It´s A Boy!|It’s a Boy!]]“, London)
 
* [[Victor Schonfeld]] (Filmmaker, documentation „[[It´s A Boy!|It’s a Boy!]]“, London)
 
* [[Ulrich Fegeler]] (press officer [[BVKJ]] e.V.)
 
* [[Ulrich Fegeler]] (press officer [[BVKJ]] e.V.)
Line 218: Line 317:
 
* [[Viola Schäfer]] (chairwoman [[intaktiv]] e.V. – a voice for genital self-determination)
 
* [[Viola Schäfer]] (chairwoman [[intaktiv]] e.V. – a voice for genital self-determination)
  
−
== Footnotes and references ==
+
{{ABBR}}
−
<references />
+
{{REF}}
  
 
{{DEFAULTSORT:Twentythousand}}
 
{{DEFAULTSORT:Twentythousand}}

Latest revision as of 23:12, 30 December 2023

2017, intactivist Hannes Müller meticulously investigated where the argument of the 20,000 nerve endings in the male foreskin used by so many intactivists comes from and whether it applies. He has summarized his findings in a document that we are happy to fully reproduce here.

Demythologization of the "20,000 nerve endings” legend

Result of an Internet research by Hans Helmut „Hannes“ Müller[1], 2017-12-12.

Second, revised and enhanced version of the first release from 2017-10-02.

“ … neither of these [figures >10,000 and >20,000] is anywhere near the truth, because they are an order of magnitude too high.
– Ken McGrath[2]
“ In orders of magnitude, the number has to be >1,000 and <10,000.
– Ken McGrath[2]

I wish to thank Ulf Dunkel and Lindsay R. Watson for support and advice in the preparation of this article and Ken McGrath for giving his consent and information about anatomy and innervation of the foreskin.[3]

The myth

A frequent argument against the non-therapeutic foreskin amputation is the concept that the foreskin not only contains numerous nerve endings and is more sensitive for touch than the glans, but also that the number of nerve endings is “more than 10,000”, "(more than) 20,000" or even "up to 70,000" or “100,000”. There appears to be no reliable evidence for these figures.[4] Nevertheless, this article identifies the origin and the calculation of these figures, explains how credible they are, and what magnitude range is the most realistic.

The Intactivists movement, which promotes the idea that the possession of intact genitals is a human right, is active against the genital mutilation of all children. Intactivists clarify many widespread myths about circumcision, especially those concerned with male genital cutting. Advocates of circumcision often allege there are advantages. But the results of evidence-based scientific studies disprove these. They provide convincing arguments that the foreskin is not a superfluous piece of skin, but a part of the body with many positive functions and its lack leads to many disadvantages. To explain this, it is important to provide reliable, i.e. also verifiable, information about the anatomy of the foreskin.

Medical studies of the past 25 years have provided much good evidence for intactivists. Evidence can be found, for example, that the foreskin, especially at the end, is very densely supplied with nerve endings[5], and is very sensitive to fine touch, even more sensitive than the glans[6]. Basically this is enough to emphasize the special sensitivity of the foreskin. However, it is in this connection that the above figures are often quoted.

The traceable story of the legend of "20,000 nerve endings" began in October 1997, when the article "The Case Against Circumcision"[7] by Paul Fleiss appeared in the popular mothers’ magazine “Mothering”. This is the first documentation of the ‘fact’, that the foreskin contains "more than 20,000 nerve endings". Fleiss referred to an article from 1932 by the English physiologist H. C. Bazett (1885-1950) together with other authors within a medical scientific journal.[8]

The popular American pediatrician Paul Fleiss (1933-2014), in empathy with the children, was very active against the genital mutilation of newborns by RIC(non-therapeeutic) (Routine Infant Circumcision) in USA. Fleiss, Marilyn F. Milos, and alongside them many other [intactivist]] pioneers, have contributed enormously to explaining its negative consequences. Fleiss knew of the article by Bazett et al. (1932) through the medical historian F. Hodges. Fleiss and Hodges were well known to each other. They appeared both in the 1995 film “Whose Body, Whose Rights?”[9], and together they co-authored several articles[10] and two books[11]. In “The Case Against Circumcision” Fleiss referred to Hodges’ article: “A short history of circumcision in the United States” from Jan. 1997, wherein Hodges writes about Bazett’s “detailed anatomical description of the innervation of the foreskin.”[12]

The dissemination of Fleiss’ article took place through the Intactivist movement through NOCIRC, Doctors Opposing Circumcision (D.O.C.)], NOHARMM, NRC and “Mothers Against Circumcision”, amongst others.[13]

However, in the article by Bazett et al. (1932),[8] no number is given for the nerve endings in the foreskin as a whole. Only a count of 212 nerve endings in a 1 cm² piece of a single prepuce tissue is given (see Table 1, p. 492). The 29-page Bazett article of 1932[8] to which Fleiss refers as a source for his "20,000", without mentioning the page, is only provided with "Conclusions" at CIRP: "For both technical reasons and perceived lack of general interest, CIRP will not present these parts and will only transcribe the conclusions." — the entire article is available in the archive of "The JAMA Network"[14]. The article may be available in 2019 but it was not available in the spring of 1997.

How did Fleiss come to this number, which is nowhere documented?

The number of nerve endings in normal skin

As early as 1971, the anthropologist Ashley Montagu (1905-1999) had written in a study on the importance of skin as a tactile organ for the social development of man: “A piece of skin the size of a quarter [25-US-cent piece] contains more than […] 50 nerve endings, […]”[15]

The size of a foreskin

1992 (21996) appeared in the small book "Say No to Circumcision" of T.J. Ritter and G.C. Denniston (D.O.C.): "Circumcision removes a piece of skin (that in the adult is) almost equivalent to a 3 × 5 index card.”[16] Thus, the foreskin size of an adult was given as 3×5 = 15 sq.inch = 96.8cm²[17], going out of about 1.5 inches = 3.81cm in length for inner and outer foreskin sheet and 5 inches = 12.7cm circumference. This too is found in Fleiss and Hodges, 2002[18]. The length also is indicated to be about 4cm and the circumference 13cm, which leads to an area of 8×13=104 cm².[19] Size-measuring studies give a maximum (not average!) area of 99.8 cm².[20]

Nerve endings in the foreskin / Quarter (25-US-Ct.)

1995, in the film "Whose Body, Whose Rights?"[9] starting from Montagu's description of the number of nerve endings in normal skin, the number of nerve endings in the foreskin was calculated as follows: “15 square inches comfortably fits 15 quarters. This analogy helps us to understand that the adult foreskin contains … over 1000 nerve endings …" (15 × more than 50 = more than 750), which NOHARMM supplements to "Since Dr. Taylor's research suggests that the foreskin is more densely innervated than "normal" skin, a circumcised man likely loses many times more than 1,000 nerve endings.”[19]b

The “ridged band"

In 1996 the article by the Canadian pathologist John R. Taylor et al.[5] about the “ridged band” of the foreskin had appeared. Taylor reported, that the encapsulated nerve endings[21] of the foreskin are concentrated in the “ridged band” and thus are distributed very differently. In his article, Fleiss also mentions the "ridged mucosa" and calls Taylor as a source. He therefore knew of Taylor’s work.

Nerve endings in the foreskin / 1cm²

In 1997 Fleiss knew from Bazett et al. (1932).[8],[14] that they had counted 212 nerve endings within a 1cm²-piece of a single foreskin tissue (Table 1, p. 492). Now it is obvious that Fleiss reckoned similarly therewith and with the foreskin size of 15 sq.inch = 96.8 cm² (or with 8×13 = 104 cm²): 96.8 cm²×212 nerve endings / cm² = 20,522 nerve endings (or 104×212 = 22,048; short: 100×>200= >20,000). So he obviously came to "more than 20,000 nerve endings".

Not a “logical extrapolation”[16]

It is completely insufficient, outgoing from only one single 1cm²-piece of prepuce tissue and the greatly different distribution of the nerve endings therein, to derive from it generally a number of nerve endings of the foreskin as a whole. This is all the more true, if it is not known where exactly the tissue was taken from on the foreskin, and how old it was.

The widespread dissemination of the legend

2002 Fleiss and Hodges published: “What Your Doctor May Not Tell You About Circumcision“[11]b. According to the book: "the foreskin contains … tens of thousands of specialized erogenic nerve endings …"(S.2f).

2009 Marilyn Milos wrote: “20,000-70,000 highly specialized erogenous nerve endings encircle the opening of the foreskin.”[22], also in the years 2012, 2013, 2015.[23]

These and many other publications have spread the legend of “20,000 …” widely.[4] Often, the legend is made more believable by giving the impression that it is verifiable. So it is often linked in publications with a ref. note, which does not mention the number, like at first 1997 in the article of Fleiss[7],[24]. Sometimes the impression is given that a figure which is the maximum is average[18],[20],[25], or nerves are referred to instead of nerve endings[26] – a big difference in number.

McGrath's estimate

„>1000<10,000“

Ken McGrath, New Zealand senior lecturer in pathology and anatomist (now retired), estimated the number of nerve endings in the prepuce, Summer 1998:

“ I did a quick back-of-the-envelope guesstimate based on a fingertip and arrived at an orders of magnitude figure of >1000<10000 … this figure quickly inflated, first to >10,000 and then to >20,000; neither of these is anywhere near the truth, because they are an order of magnitude too high. …”[27]
– Ken McGrath

Claim from Stephen Moreton, Ph.D.[a 1], that Ken McGrath has given a previous higher estimate in a 2008 e-mail[28] is refused by Ken McGrath as not being by him.[29]

In 2017, Ken McGrath confirms his estimate from 1998[30]:

“ The following method has been used to estimate the number of corpuscular nerve endings in the foreskin. The frenular delta and frenular band are more sensitive than a fingertip; one square centimetre of fingertip has about 30-40 ridges with approximately three Meissner's corpuscles in every millimetre of ridge. For each centimetre of ridge there would be thirty Meissner's corpuscles and thus 900-1200 per cm2 of tip. The area of the frenular delta is equivalent to or greater than three fingertip areas, i.e. about 3-4 cm2. Therefore, at a minimum, the most sensitive area of the prepuce would have at least 3000 corpuscular endings. In orders of magnitude, the number has to be more than 1000 and less than 10,000. Some writers have erroneously inflated this estimate to 20,000 or more. More research is needed to clarify the actual number and distribution.
– Ken McGrath

And in a further actual statement about the 20,000 figure McGrath writes:

“ […] it is impossible for the foreskin to support such a huge number: there is not enough surface area to mount so many receptors (they would nearly outnumber the epithelial cells!) and the known number of axons ranging into the prepuce could not connect to that number. Furthermore, such a vast number is totally unnecessary to achieve the known high sensitivity of the prepuce.
– Ken McGrath

In a further e-mail from 19.09.2017 to the author Ken McGrath writes about his estimate:

“ I made my estimate at the Symposium held in Oxford UK, Summer 1998. … I made my informal ‘back of the envelope’ estimation in response to a question during discussion outside the meeting. … Paul Fleiss did not differentiate between the types [of nerve endings] either and simply took Bazett's total number for his estimate.

In my estimation, I extrapolated the numbers of Meissner corpuscular endings from the finger tip to the prepuce as these are the principal mediators of fine touch (and, therefore, of sexual sensation). All skin appears to have many free nerve endings evenly distributed over their surfaces regardless of the local function; two epithelia, however, have virtually no fine touch—the cornea of the eye and the glans penis—having almost nothing but free nerve endings. The prepuce is no exception to this general pattern of having FNE over its entire surface, but like most other skin (except the two exceptions above) it has varying numbers and distribution of corpuscular endings which are in lower numbers than the FNE. From teaching skin enervation to medical students using sections of an index finger, I knew the numbers of Meissner's corpuscles in that skin. Observation and personal experience told me that the prepuce was more sensitive than the finger tips which suggested there are more of those fine touch endings in the prepuce. But I could not be definite about the numbers in the prepuce having only looked at some general sections. So I made an estimate in orders of magnitude: not less than 1000 nor more than 10,000 with the view that the numbers were probably at the lower end; i.e. between 1000 and 2000. Some recent work seems to confirm a figure around 1500.
– Ken McGrath

A purely quantitative consideration for plausibility speaking against “20,000 nerve endings” in the foreskin

The genital tissue by male and woman is probably not so far different. The difference is mainly in the form and the nerve endings are differently distributed in detail, but on the whole their number maybe nearly equal. The glans of the penis may have 4k and the clitoris 8k. If the foreskin for instance has 10k, then the number of nerve endings in the whole would be 14k, so that the non-clitoridal genital has 6k, with the same total number in men and women. If the foreskin has 12k, then there is 16k together with the glans, and the non-clitoridal genital has the same as the clitoris: each 8k. If the female non-clitoidal genital has less than the clitoris, for example max. 6k, ie together max. 14k, then stays for the foreskin max. 10k. – Gender equality seems possible: for the whole 12k, clitoris or foreskin 8k, non-clitoridal genital or glans 4k.

Conclusion

It is time to take leave of the exaggerated number of 20,000 nerve endings in the foreskin.[31] This legend is very wide spread by the opponents of circumcision. As long as the number cannot be scientifically proven, it is sufficient to say that the prepuce is very densely innervated and for fine touch is more sensitive than the glans[3] [4]. Otherwise, the credibility and persuasive power of the Intactivist movement suffers and makes itself unnecessarily vulnerable. Unfortunately, this can also be seen on the Internet.

Statements on foreskin anatomy should be evidence-based on studies published in scientific journals, to keep them verifiable and comprehensible. This should be taken seriously. Publications containing the 20,000 (or 10,000 and more) legend should no longer be disseminated. We should make sure our articles are accurate and add correcting notes to published articles where possible.

“ If you make a mistake and do not correct it, this is called a mistake.
– Confucius

Dr. Fleiss, however, is no longer with us, so no explanation or correction may be expected from him. It is likely that when he prepared the article for publication in the popular press in 1997, he simply meant to informally express the concept of a very substantial innervation of the foreskin as had been previously reported by Taylor et al.[32]

Appendix: Documentary Part – Internet research by Hannes Müller

First release: May 12, 2017, revised and enhanced: Dec 12, 2017

The legend of "20,000 nerve endings"

The assertion that the male foreskin contains "20,000 nerve endings" is often encountered in the case of circumcision opponents. I also used this figure in texts of mine. When I was asked for a proof, I searched for hours without success. Instead of a proof, one only comes across a widespread legend as documented in the following. – Concerning hearsaying about extrapolation using the density in a small cross-section: there are no scientific publications thereabout. See also:

  • gbs-Flyer "My body belongs to me!" of the AK Children's Rights, 2012[33]: "„[…] within it [the foreskin] some 20,000 sensitive receptors run together" - without proof.
  • intaktiv e.V., Flyer: "Circumcision" of boys, 2016[34]: "With about 20,000 special nerve endings the foreskin … is the most sensitive part of the male body, ..." - without proof.
Note: IntactiWiki has updated the relevant text to "The foreskin contains very many nerve endings ..." since then.
  • PflegeWiki: "And more than 20,000 nerve endings are irreversibly removed."[38] - In the link to Bazett et al. there is no such number.
  • Book of M. Franz: „Die Beschneidung von Jungen – Ein trauriges Vermächtnis“: Even there it is without proof: "it [the foreskin] has around 20,000 nerve endings, ..." - The reference to Hartman 2012 contains no number and the on Jaermann 2010 gives "over 1000": Scheinfeld in M. Franz, Die Beschneidung von Jungen, 2014, p. 364
  • Book of L.R. Watson: “... there are tens of thousands of nerve endings, …”(K. Hakuya, Es beginnt mit einem Teil, in L.R. Watson, Unaussprechliche Verstümmelungen, 2015, p. 101) – without proof.
  1. "The foreskin contains 10,000 to 20,000 so-called specialized nerve endings of different types, ..."[39] – not documented (not with Sorrel, McGrath, Taylor, who only report more sensitivity than the glans from highly innervated tissue).
  2. " … a circumcised man actually loses many more than 1000 nerve endings. (About 20,000 nerveendings)."[40] - From the indicated source (Montagu A., Matson F. The Human Connection, NY: McGraw Hill, 1979), no 20,000 can be derived as the number of nerve endings. - The quoted quote is also incomplete: "15 U.S. quarters" are translated with "25-US-Cent coins" without the "15".[41]
  3. "Careful anatomical studies have shown that through circumcision [...] more than 70 m of nerves, and more than 20,000 nerve endings are lost."[42] – The indicated source[43] provides only "Conclusions". The number 20,000 did not appear until 1997 (see below).
  4. "Physical effects of circumcision. John Warren, Royal College of Physicians, London, UK; NORM-UK, Staffordshire, UK; Excerpt ... loss of at least 10000 to 20000 specialized erotogenic nerve endings, .... [...] It was calculated that at least 10000 -20000 specialized erotegenic nerve endings are removed during circumcision. (Winkelmann, 1959, 1956)."[44] And: "Graphics added later [!]. ... Citations of the English original article: Warren J. Physical Effects of Circumcision. In: Denniston GC, Milos MF, Hodges FM (eds.). Genital Autonomy: Protecting Personal Choice. Heidelberg, New York: Springer; 2010. p. 75-79." – But there is no calculation. “20,000” in the graphic is without proof.
  5. "Infos for Parents: What is the foreskin": "What is the foreskin? Anatomical and physiological facts of Dr. med. Paul M. Fleiss and Dr. Phil. Frederick Hodges [...] In fact, the foreskin contains more than 70 meters of nerve fibers and tens of thousands of specialized erotogenic [...] nerve endings ... "[45] (graphic like above) "Citation of the English original text: Fleiss, Paul M; Hodges, Frederick. What Your Doctor May Not Tell You About Circumcision. New York: Warner Books; C2002. Chapter 1, What is the foreskin. Anatomical facts, that your doctor may not know; p. 1-17."
    This text[46] by Fleiss and Hodges and an earlier article by Fleiss[7] in 1997 seem to be the source of the greatly exaggerated misleading vacant figure of 20,000.
  • In the Circumcision Forum, the assertion of the "20,000 nerve endings" is spread without proof:
  1. https://www.beschneidungsforum.de/index.php/Thread/5138-Unsicher-ob-oder-ob-nicht/
  2. https://www.beschneidungsforum.de/index.php/Thread/6962-Meine-Fehl-Beschneidung/?postID=50265&highlight=20.000%2BNervenenden#post50265
  3. https://www.beschneidungsforum.de/index.php/Thread/6912-Warum-fr%C3%BChzeitige-Beschneidung/?postID=49819&highlight=20.000%2BNervenenden#post49819
  4. https://www.beschneidungsforum.de/index.php/Thread/5259-Unprofessioneller-Journalismus-wie-swissmom-ch-junge-M%C3%BCtter-%C3%BCber-den-Penis-und-d/?postID=37698&highlight=10000%2BNervenenden#post37698 („NOHARMM knows“) Even NOHARMM does not know, but copies only what is not prooved: “The foreskin contains branches of the dorsal nerve and between 10,000 and 20,000 specialized erotogenic nerve endings … from a list compiled by Gary L. Harryman (NORM/Southern California)”[47] – Specified sources do not provide any proof! (See: https://www.beschneidung-von-jungen.de/home/infos-fuer-eltern/was-durch-die-beschneidung-verlorengeht.html : "Gary L. Harryman, February 14, 1999")
  5. https://www.beschneidungsforum.de/index.php/Thread/4807-Gibt-es-eine-Bescheidungs-Methode-ohne-schmerzen-wenn-die-Vorhaut-abgeschn%C3%BCrt-wi/?postID=33736&highlight=10000%2BNervenenden#post33736 : "Loss of 10,000 to 20,000 nerve endings"
  6. https://www.beschneidungsforum.de/index.php/Thread/1660-Erkl%C3%A4rung-von-Volker-Beck-et-al/?postID=10717&highlight=20000%2BNervenenden#post10717 : "The clipping of a clitoral foreskin is not comparable with amputating the entire penis foreskin. Clear: The entire clitoris including foreskin has only 8000 nerve endings, the male foreskin alone but 20000. Therefore, this is not comparable. Already confusing." Such a confusing misfortune then comes out as a result of the phantased "20,000".
  7. https://www.beschneidungsforum.de/index.php/Thread/4649-England-Why-the-UK-has-no-moral-right-to-tell-Africans-to-stop-genital-mutilatio/?postID=32474&highlight=20000#post32474 : "The [up to 20,000 nerve endings] is by the way an urban legend. There are about 10,000 cells. No one knows where the 20,000 come from. I think this is only a quotation and nowhere with source." (G.) "10,000 to 20,000" noharmm.org/advantage.htm The "urban legend" probably originates from Fleiss, P.M. (1997) The case against circumcision. Mothering, Winter, 36-45 (see below)
  • FB page of the circumcision forum: [48] It accepts here the page with the empty claim of the "20,000 nerve endings" from the "DocCheck Flexikon"[49]: “On average, the foreskin has about 73m of nerve fibers around 20000 mostly specialized nerve endings ..."
  • Ken McGrath (Email 5.7.2013 to Stephen Moreton Ph.D.[a 1]): “No one since about 1923 has published a count of neural receptors in the human penis. At a conference (1998 in Oxford I think) a group asked me to make an estimate of the number of nerve endings in the prepuce. I did a quick back-of-the-envelope guesstimate based on a fingertip and arrived at an orders of magnitude figure of >1000<10000. … this figure quickly inflated, first to >10,000 and then to >20,000; neither of these is anywhere near the truth, because they are an order of magnitude too high.” (emphasis from the author) http://circfacts.org/sensitivity/
  • Moreton: “Unlike 10,000, this one [20,000] has a printed source, though not a credible scientific one. It originated in an article that is still influential amongst intactivists to this day, by the late osteopath Paul Fleiss, published in “Mothering: the magazine of natural family living” (Fleiss, 1997).”
  • Fleiss on MothersAgainstCirc.org[50]: The Case Against Circumcision, Paul M. Fleiss, 1997: “Circumcision denudes: … circumcision cuts off … 240 feet of nerves, and more than 20,000 nerve endings. [H. C. Bazett et al., "Depth, Distribution and Probable Identification in the Prepuce of Sensory End-Organs Concerned in Sensations of Temperature and Touch; Thermometric Conductivity," Archives of Neurology and Psychiatry 27 (1932): 489-517]” - There is no proof for "20,000"!

Approvals to the first publication by e-mail to the author

Abbreviations

  1. ↑ a b REFweb Doctor of Philosophy, Wikipedia. Retrieved 16 June 2021. (Also abbreviated as D.Phil.)

References

  1. ↑ The author is senior physiotherapist in retirement (main emphasis neurology: Bobath-, Brügger-, Pain-PT).
  2. ↑ a b see footnotes 27 and 31
  3. ↑ a b Approvals to the first publication by e-mail to the author: see below
  4. ↑ a b c see Appendix: Documentary Part, p. 5f. – Ditto on facebook: The legend of the “20,000 nerve endings”:
  5. ↑ a b REFjournal Taylor JR, Lockwood AP, Taylor AJ. The prepuce: specialized mucosa of the penis and its loss to circumcision. Br J Urol. 1996; 77: 291-5. PMID. DOI. Retrieved 23 September 2019.
  6. ↑ REFjournal Sorrells ML, Snyder JL, Reiss MD, Eden C, Milos MF, Wilcox N, Van Howe RS. Fine‐touch pressure thresholds in the adult penis. BJUI. 19 March 2007; 99(4): 864-9. PMID. DOI. Retrieved 10 January 2021.
  7. ↑ a b c REFjournal Fleiss P. The case against circumcision. Mothering Magazine (Santa Fe). 1997;
  8. ↑ a b c d REFjournal Bazett HC, McGlone B, Willams RG, Lufkin HM. I. Depth, distribution and probable identification in the prepuce of sensory end-organs concerned in sensations of temperature and touch thermo-metric conductivity. Arch Neurol Psychiatry. 1932; 27(3): 489-517.
  9. ↑ a b REFweb film "Whose Body, Whose Rights?", YouTube.
  10. ↑ Letter; Neonatal circumcision does not protect against penile cancer; foreskin IS NECESSARY; AIDS and circumcision; Circumcision in infancy; Authors’ reply; Immunological functions of the human prepuce
  11. ↑ a b a) Sweet Dreams 2000; b) www.amazon.com/What-Your-Doctor-About-Circumcision/dp/0446678805 2002
  12. ↑ http://www.historyofcircumcision.net/index.php?option=com_content&task=view&id=90&Itemid=0: Fn 50
  13. ↑ http://www.nocirc.org/; http://www.doctorsopposingcircumcision.org/; http://www.noharmm.org/; http://childrightsnurses.org/; “For More Information”: http://www.mothersagainstcirc.org/fleiss.html
  14. ↑ a b http://jamanetwork.com/journals/archneurpsyc/article-abstract/645191
  15. ↑ A. Montagu, Touching: The Human Significance of the Skin, 1971, 21978, p. 4; https://archive.org/stream/youchingthehuman000780mbp/youchingthehuman000780mbp_djvu.txt and 1979: http://www.foreskin.org/quarter.htm
  16. ↑ a b REFweb Global Survey of Circumcision Harm. Retrieved 1 September 2021.quoted in
  17. ↑ REFweb 15Square. Retrieved 1 September 2021. ("15 Square" = trade name of NORM-UK)
  18. ↑ a b see Fn 9b, p. 4. Mistranslation in “Beschneidung-von-Jungen.de“: „ungefähr die Größe einer 4[!]x5 Zoll (also: 10x12,5cm) Karteikarte“ [but in the picture animation: “100cm²”]. → 125×212 = 26,500 nerve endings. http://archive.is/20130903162537/www.beschneidung-von-jungen.de/home/infos-fuer-eltern/was-ist-dievorhaut/ was-ist-die-vorhaut-anatomische-und-physiologische-fakten.html#selection-603.105-603.168
  19. ↑ a b a) http://www.circumcisionharm.org/gallery%20intact.htm and b) http://noharmm.org/snip.htm
  20. ↑ a b see: Werker et al. (1998) and Kigozi et al. (2009).
  21. ↑ Nerve endings can be divided into types with or without end corpuscles (corpuscular/encapsulated or free nerve endings). “… the free nerve endings (FNE) … do not seem to have any part in fine touch sensation (they are innervated by unmyelinated axons which conduct too slowly, don’t have specialised end corpuscles to transduce vibration, etc. and have a high threshold, all of which prevent the conduction of fine touch).” McGrath, Fn 29b
  22. ↑ http://lifeissavage.com/2009/07/31/the-baby-chronicles-28-weeks-1-day/ , also: www.savingsons.org/2009/10/
  23. ↑ 2012: http://mommydocs.com/2012/03/to-circumcise-or-not-to-circumcise/?replytocom=2094
    2013: https://link.springer.com/chapter/10.1007%2F978-94-007-6407-1_3 ;
    2015: https://www.regulations.gov/document?D=CDC-2014-0012-2326.[“nerve” instead of n.-endings!]
  24. ↑ in: beschneidung-von-jungen.de/Nachteile, also in: https://schariagegner.wordpress.com/2013/12/28/
  25. ↑ a.) according to McGrath’s e-mail from 18.09.2017 to the author: “… the message to which he refers was from another of the colleagues who inflated the figure.” b.) In an e-mail from 27.09.2017 to the author McGrath writes: “I have no idea where the ’70,000’ number comes from. It is even more impossible, absurd even, than the 20,000 estimate. It is probably representative of the inflation of the number brought on by wishfull thinking and should be ignored.”
  26. ↑ intaktiv e.V.-Flyer, German 22016: http://intaktiv.de/downloads/flyer/ ; Fn 21, 2015; Fn 22, 1. Link
  27. ↑ So the numbers „70,000+“ and „between 80,000 and 100,000” are found on the internet, see: http://www.savingsons.org/2009/10/ ; https://www.vice.com/de_ch/article/7bm5gx/ein-mann-und-seine-vorhaut many more by searching on internet.
  28. ↑ in www.circfacts.org/sensitivity
  29. ↑ a.) according to McGrath’s e-mail from 18.09.2017 to the author: “… the message to which he refers was from another of the colleagues who inflated the figure.” b.) In an e-mail from 27.09.2017 to the author McGrath writes: “I have no idea where the ’70,000’ number comes from. It is even more impossible, absurd even, than the 20,000 estimate. It is probably representative of the inflation of the number brought on by wishful thinking and should be ignored.”
  30. ↑ McGrath’s statement in a contribution to a yet unpublished book (emphasis from author), made available to the author by forwarded email from L.R. Watson to Ulf Dunkel on May 31, 2017.
  31. ↑ If you want to name a number, you should only specify the order of magnitude >3,000 <10,000. The number of nerve endings in the foreskin is probably at least 4,000, since the glans already has 4,000 and the foreskin is more sensitive — but this is not qualitatively differentiated, for instance between sensitivity to pain or touch.
  32. ↑ REFjournal Taylor JR, Lockwood AP, Taylor AJ. The prepuce: specialized mucosa of the penis and its loss to circumcision. Br J Urol. 1996; 77: 291-5. PMID. DOI. Retrieved 23 September 2019.
  33. ↑ REFweb My body belongs to me. Retrieved 31 August 2021.
  34. ↑ REFweb A voice for genital autonomy. Retrieved 31 August 2021.http://intaktiv.de/downloads/flyer/
  35. ↑ REFweb The big Circumpendium. Retrieved 31 August 2021.
    Quote: “… the foreskin is saturated with roughly 20,000 nerve endings and tactile corpuscles, …”
  36. ↑ REFweb Das große Zirkumpendium. Retrieved 31 August 2021.
  37. ↑ REFweb Circumcision. Retrieved 31 August 2021.
  38. ↑ REFweb PflegeWiki - In Bearbeitung.
  39. ↑ REFweb Beschneidung und Sexualität. Retrieved 1 September 2021.
  40. ↑ REFweb Der Penis und die Vorhaut: Die Anatomie der Vorhaut und ihre sexuelle Funktion. Retrieved 1 September 2021.
  41. ↑ See: http://webcache.googleusercontent.com/search?q=cache:jfxXKByh1GQJ:www.noharmm.org/snip.htm+&cd=5&hl=de&ct=clnk&gl=de
  42. ↑ https://www.beschneidung-von-jungen.de/home/wichtige-trendumkehr-in-den-usa/wieso-schadet-die-beschneidung.html
  43. ↑ REFweb Bazett, HC (March 1932). I. Depth, distribution and probable identification in the prepuce of sensory end-organs concerned in sensations of temperature and touch thermometric conductivity. Retrieved 1 September 2021. (THE CIRCUMCISION REFERENCE LIBRARY. ARCHIVES OF NEUROLOGY AND PSYCHIATRY, Vol. 27, Number 3: Pages 489-517, March 1932.)
  44. ↑ REFweb Warren, John. Körperliche Auswirkungen der Beschneidung. Retrieved 1 September 2021.
  45. ↑ https://www.beschneidung-von-jungen.de/home/infos-fuereltern/was-ist-die-vorhaut/was-ist-die-vorhaut-anatomische-and-physiological-fakten.html
  46. ↑ REFweb What your doctor may not tell you about circumcision. Retrieved 1 September 2021. p. 2f.
  47. ↑ http://www.noharmm.org/advantage.htm
  48. ↑ https://www.facebook.com/beschneidungsforum.de/posts/1785501095046354
  49. ↑ REFweb Fink, Bijan. Sexuelle Auswirkungen der Zirkumzision, DocCheck, Einfach Eintauchen. Retrieved 3 September 2021. (only German version)
  50. ↑ REFweb Fleiss, Paul (1997). The case against circumcision. Retrieved 2 September 2021.
  51. ↑ On 12.10.2017 the German and English first version of the article were posted with an accompanying text on Facebook: https://www.facebook.com/groups/248240545511361/534302533571862/. Morten Frisch shared and linked the article on Facebook on 28.10.2017 and wrote a post in which he called to mention no exaggerated numbers, thanked the author and recommended reading the article. He then received 93 likes, including 89 from Denmark, Marilyn F. Milos, Lloyd Schofield (president of Bay Area Intactivists), Brian D. Earp and Georg Zimmermann (University of Osnabrück, formerly human rights activist at intactivism); please refer: https://www.facebook.com/morten.frisch/posts/10214297927219433?pnref=story .
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